Prairie Hills Transit Notice of Public Rights

Prairie Hills Transit policy is that no person shall on the grounds of race, color, gender, religion, national origin, age or disability, according to be excluded from participation in, be denied the benefits of, or be subjected to discrimination in any operation of PHT as provided by the provisions in Title VI of the Civil Rights Act of 1964, Section 504 of the Rehabilitation Act of1973 and other civil rights statutes.
Any person who has questions concerning this policy or who believes he or she has been discriminated against should contact the Director at 605-642-6668.
If you would like to send a formal complaint, please click on the form below and submit online or by mail to 2015 Tumble Weed Trail, SD 57783.

​ADA Complaint and Title VI Procudure  

ADA Complaint and Title VI Form  

Fill out and submit your Discrimination Complaint and Title VI Form

Name:

Address:
City:
Zip:

Home Phone:
Work Phone:
Mobile Phone:

Email:

Basis of Complaint (check all that apply):

Race
Color
National Origin
Sex/Gender
Age
Disability
Retaliation
Other

Who discriminated against you?

Name:

Organization:

Address:
City:
Zip:

Phone:

How were you discriminated against?

Where did the discrimination occur?

Dates and times discrimination occurred?

Were there any other witnesses to the discrimination?

1.) Name:

Orginization / Title:

Work Phone:

Home Phone:

2.) Name:

Orginization / Title:

Work Phone:

Home Phone:

3.) Name:

Orginization / Title:

Work Phone:

Home Phone:

How would you like to see this situation resolved?

Have you filed your complaint, grievance, or lawsuit with any other agency or court?

Who:

When:

Status (pending, resolved, etc.)

Result, if known:

Complaint number, if known:

Do you have an attorney in this matter?

Name:

Phone:

Address:
City:
Zip:

Filing a complaint with Prairie Hills Transit is voluntary. However, without the information requested, PHT may be unable to proceed with your complaint. We collect this information under authority of Title VI of the Civil Rights Act of 1964, Section 504 of the Rehabilitation Act of 1973 and other civil rights statutes. We will use the information you provide to determine if we have jurisdiction and, if so, how we will process your complaint. Information submitted on this form is treated confidentially and is protected under the provisions of the Privacy Act of 1974. Names or other identifying information about individuals are disclosed when it is necessary for investigation of possible discrimination, for internal systems operations, or for routine uses, which include disclosure of information associated with civil rights compliance and as permitted by law. It is illegal for a recipient of Federal financial assistance to intimidate, threaten, coerce, discriminate or retaliate against you for filing this complaint or for taking any other action to enforce your rights under Federal civil rights laws. You are not required to use this form. You also may write a letter or submit a complaint electronically with the same information. To mail this complaint send to 2015 Tumble Weed Trail, Spearfish, SD 57783 or Fax to 605-642-6434.

   I understand that by submitting this form I acknowledge that all statements made are true and accurate to the best of my knowledge. And that under federal law (18 U.S.C§ 1001) I may face prosecution and penalties of fine or imprisonment for conviction for making fraudulent or fictitious statements